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作者：Laurie Barclay, MD  
出處：WebMD醫學新聞

　　June 10, 2010 —根據發表於6月號糖尿病照護期刊的護士健康研究II分析結果，體重過重女孩減重可能降低成人時期糖尿病風險。
　　
　　主要作者，來自馬里蘭班賽斯達Eunice Kennedy Shriver國家兒童健康以及人類發展機構的Edwina Yeung博士在一篇新聞稿中表示，這些發現代表確保過重兒童減重對於限制她們成人時發生糖尿病的風險是很重要的。
　　
　　這項分析的目的在於評估兒童時期過重，還有其他時期體重特徵，與成人時期發生第二型糖尿病的關係。
　　
　　在護士健康研究II中，總共有109,172位女性在5、10、20歲時以9個程度的插圖圖表（體型圖）讓她們回想身體脂肪程度，反映極瘦（第1類）到肥胖（第9類）。以回想18歲時的體重與成人時的體重計算身體質量指數（BMI）。那些報告罹患第二型糖尿病的參與者完成附帶的問卷。
　　
　　5歲與10歲時的體態正向地與成人時期發生糖尿病風險增加有關（趨勢P值<0.0001）。5歲時，體型至少"6"相較於"2"，成人時期發生糖尿病相對風險（RR）為2.19（95%信賴區間[CI]為1.79-2.67）。在10歲時，體型至少"6"相較於"2"，成人時期發生糖尿病相對風險（RR）為2.57（95% CI為2.20-3.01）。從18歲開始，體態或體重增加風險也會繼續上升。
　　
　　相較於那些體重從未過重的女性，成人時過重（BMI > 25 kg/m2），而非成人時期之前，校正後RR為8.23（95% CI為7.41-9.15）。10歲時（體態大於等於"5"）和18歲時（BMI > 25 kg/m2）體重過重女孩，校正RR為15.10（95% CI為13.21-17.26）。兒童時期體態變胖但成人時期並未持續過重的女性，成人時期的糖尿病風險並未上升。
　　
　　研究作者們寫到，兒童時期體型變胖與成人時期糖尿病風險上升有關。然而，成人時期變瘦風險並未增加。
　　
　　這項研究的限制包括觀察性研究設計、使用回憶體態而非量測兒童體型計算BMI、侷限於高加索裔女性的一般性以及潛在的殘餘影響因子。
　　
　　作者們的結論是，我們的發現顯示，兒童時期體重過重的重要性源自於成人時期過重。從年輕時期開始鼓勵她們改變生活型態仍是重要的，因為可以避免不好的走向。已經有人提出可以改變兒童時期過重的多重介入，但是這些介入仍需要進一步地檢驗。
　　
　　國家兒童健康與人類發展機構、國家癌症機構以及國家糖尿病、消化與腎臟疾病機構提供這項分析的經費。研究作者們表示沒有相關資金上的往來。


Weight Loss by Overweight Girls May Lower Risk for Diabetes in Adulthood

By Laurie Barclay, MD
Medscape Medical News

June 10, 2010 — Weight loss by overweight girls may lower their risk for diabetes in adulthood, according to the results of an analysis from the Nurses' Health Study II reported in the June issue of Diabetes Care.

"These findings suggest that ensuring that overweight kids reverse their weight gain is critical to limiting their future risk of diabetes as adults," said lead author Edwina Yeung, PhD, from the Eunice Kennedy Shriver National Institute of Child Health and Human Development in Bethesda, Maryland, in a news release.

The goal of this analysis was to evaluate the association of childhood overweight, along with other life course weight characteristics, with the development of type 2 diabetes in adulthood.

In the Nurses' Health Study II, a total of 109,172 women reported on their recalled level of body fatness at ages 5, 10, and 20 years using 9-level pictorial diagrams (somatotypes) reflecting extreme thinness (category "1") to obesity (category "9"). Body mass index (BMI) was calculated from recalled weight at age 18 years and in adulthood. Those participants who reported having type 2 diabetes completed a supplementary questionnaire.

Somatotypes at ages 5 and 10 years were positively associated with the risk for diabetes in adulthood (P for trends < .0001). Women with somatotypes of at least "6" vs "2" at age 5 years had adjusted relative risks (RR) for adult diabetes of 2.19 (95% confidence interval [CI], 1.79 - 2.67). At age 10 years, the RR for somatotypes of at least "6" vs "2" was 2.57 (95% CI, 2.20 - 3.01). The risk was increased for increases in size by somatotype or by weight gain since age 18 years.

Compared with women who had never been overweight, women who were overweight as an adult (BMI > 25 kg/m2) but not before adulthood had an adjusted RR of 8.23 (95% CI, 7.41 - 9.15). For women who were also overweight at age 10 years (somatotype ? "5") and at age 18 years (BMI > 25 kg/m2), the adjusted RR was 15.10 (95% CI, 13.21 - 17.26). Women who had increased childhood size but who did not continue to be overweight in adulthood did not have an increased risk for adult diabetes.

"Increased body size starting from childhood is associated with a greater risk of diabetes in adulthood," the study authors write. "However, women who become lean in adulthood do not have an increased risk."

Limitations of this study include observational design, use of recalled somatotype instead of BMI for measurement of childhood size, generalizability limited to Caucasian women, and possible residual confounding.

"Our findings demonstrate that the importance of childhood overweight stems largely from adult overweight," the study authors conclude. "It remains important then to promote lifestyle changes from youth so that the adverse trajectory could be avoided. Multiple interventions that childhood overweight can be addressed have been suggested, but these remain to be fully tested."

The National Institute of Child Health and Human Development, the National Cancer Institute, and the National Institute of Diabetes and Digestive and Kidney Diseases provided funding for this analysis. The study authors have disclosed no relevant financial relationships.

Diabetes Care. 2010;33:1364-1369.